Provider Demographics
NPI:1336307479
Name:GIBSON, DONNA (RD LDN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 N OAKMONT ST
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-6418
Mailing Address - Country:US
Mailing Address - Phone:704-785-1043
Mailing Address - Fax:
Practice Address - Street 1:121 GREENWICH RD
Practice Address - Street 2:SUITE 215
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2355
Practice Address - Country:US
Practice Address - Phone:704-785-1043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003205133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered